For the fourth year in a row, Hawaii tops the list for healthiest state. In the annual Gallup-Healthways Well-Being Index, Hawaiians reported the highest rankings on 50 different measures of well-being including physical health, emotional health and working environment.

Hawaiians were most likely to rate their lives as “thriving,” which earned them the highest Life Evaluation score out of all 50 states. According to the report, the residents were also most likely to experience daily enjoyment, and were the least likely to have daily worry or stress. Living in paradise year-round clearly has its perks.

For the survey, a random sampling of 1,000 participants answered questions by phone about their lives every day for a year. Residents rated their state on the various measures of well-being on a scale of 0 to 100, with 100 representing the ideal. This year, Western and Midwest states dominated the rankings with seven out of the top ten spots, but Vermont and Massachusetts were two new additions to the top of the chart. Southern states had the six lowest well-being scores, a pattern that has been consistent for the last five years.

West Virginia, which had the lowest well-being score for the second year in a row, had the worst emotional health rating, with residents being more likely to report being diagnosed with depression than residents of any other state. It also had the highest percentage of obese residents. Colorado, on the other hand had the lowest percentage of obese residents and ranked highest on the Physical Health Index.

Overall, residents in high-ranking states were more likely to engage in healthy behaviors such as not smoking and eating well, whereas low-ranking states typically had lower scores in areas like access to food, medicine and shelter. “The lack of progress among the states with the lowest well-being scores may be related to low household income levels in these states. Nearly all of the states with the lowest well-being scores in 2012 are also states with the lowest median household incomes,” the survey authors write.

Well-being Index trends through the years:

Overall, well-being scores have remained relatively stable since 2008, despite an improving economy. It also suggests that certain provisions in the Affordable Care Act, such as obesity and tobacco screenings, could help improve health for low-income people. Physicians and employers can play a role in improving well-being. “Physicians can set a positive health example for their patients and employers can focus on creating an engaged workplace to help reduce the economic costs of low well-being,” the survey authors write. “Employers can also establish incentives and policies that encourage their employees to practice healthy behaviors.” Or, we could all move to Hawaii.